Introduction: Endolumenal fundoplication using the EsophyX device is a novel endolumenal treatment for gastroesophageal reflux disease (GERD). The goals of the procedure are hiatal hernia reduction and recreation of the gastroesophageal valve. Early European data have shown encouraging results with 80% of patients off proton pump inhibitors at 6 months.

Methods: The procedure is offered to patients with a hiatal hernia no larger than 2cm with normal esophageal motility and objective evidence of GERD. The patient is placed in the left lateral decubitus position after undergoing general anesthesia with nasotracheal intubation. The EsophyX device is then passed over a standard gastroscope into the esophagus and stomach. The device is operated by a single surgeon with an assistant operating the endoscope. Suction is applied to the device at the level of the Z-line and it is then advanced into the stomach, bringing the gastroesophageal junction with it and reducing any hiatal hernia. A helical retractor then screws into the gastric wall just distal to the Z-line and retracts the tissue down into the jaws of the device. Polypropylene fasteners are then delivered via a wire guide across the two apposed gastric walls.

Results: These are full-thickness serosa to serosa plications. Serial applications of the fasteners result is a 3-5 cm long plication over a circumference of 200-300 degrees.

Conclusion: Endolumenal fundoplication is safe and effective and may represent a viable endoscopic alternative to laparoscopic anti-reflux surgery in selected patients.